The shortened dental arch: A review of the literature
Debora Armellini, DDS, MS,
and J. Anthony von Fraunhofer, MSc, PhD
School of Dentistry, University of Maryland, Baltimore, Md
The functional demands of patients are highly variable and individual, requiring dental treatment to betailored to the individual’s needs and adaptive capability. The World Health Organization indicates that a functional, esthetic, natural dentition has at least 20 teeth, while the literature indicates that dentalarchescomprising theanteriorandpremolarregionsmeet therequirementsofafunctionaldentition.TheEnglish-language peer-reviewed literature pertaining to the short dental arch (SDA) was identiﬁedthrough the Medline search engine covering the period between 1966 and the present and critically reviewed. This treatment option for the partially dentate patient may provide oral functionality,improved oral hygiene, comfort, and, possibly, reduced costs.
(J Prosthet Dent 2004;92:531-5.)
o provide care for the partially-dentate or edentu-lous patient, the dentist must consider a number of factors, such as oral functionality, vertical dimension,occlusion, maintenance of hard tissue, and temporo-mandibular joint health, as well as patient comfort.The weight accorded each factor varies with the patientandtheproposedtreatment,butaquestionthatremainsis how many teeth are needed to satisfy functionaldemands.
is deﬁned in this article asthe maintenance of masticatory ability and efﬁcienc y while preserving the health of soft and hard tissues.
Forthepartiallydentatepatientwithseveralposteriorteeth,thedentistmaydesignaﬁxedorremovablepartialdenture(FPDorRPD),incorporating1ormorenaturalteeth. When the ﬁrst or second molars are present, they are usually incorporated into the prosthesis design, butit is unclear whether this is necessary to maintain oralfunctionality. In other words, should the occlusal tablebe extended to the ﬁrst and second molar teeth? A lon-ger occlusal table may be achieved with implant-supported restorations by posterior placement of theimplant, but this usually is limited to the ﬁrst molar po-sition. With implant-supported restorations, it is possi-ble to achieve posterior occlusion by cantileverextensions, although this should be limited to6 to 8mminthemaxillaand10mminthemandible.
Itisun-clear from the dental literature whether this extension iseither necessary or justiﬁed.Dentists replace missing, damaged, and severely de-cayed teeth by ﬁxed or removable prostheses to restoreorimprovemasticatoryfunction.Thereisafundamentalquestion in any treatment plan, namely, the desirable/mandatory length of an occlusal table. There have been various references in the literature to the concept of theshort dental arch (SDA) as a deﬁned treatment optionfor the partially dentate patient. While many dentistsmay accept that restoring the complete dental arch isnot always necessary, there still is the need to providethe patient with an affordable and functional treatment,a need satisﬁed by the short dental arch. The English-language, peer-reviewed literature pertaining to theshort dental arch (SDA) was identiﬁed through theMedline search engine covering the period between1966 and the present and critically reviewed. This treat-ment option for the partially dentate patient offers thebeneﬁts of oral functionality, improved oral hygiene,comfort, and possibly reduced costs.
The literature indicates that masticatory ability isclosely related to the number of teeth, and there is im-paired masticatory ability when the patient has less than20 well-distributed teeth.
In this context, the short-ened dental arch (SDA) may be deﬁned as having an in-tact anterior region butareduced number of occludingpairs of posterior teeth.
In 1992, the World Health Organization stated thatthe retention, throughout life, of a functional, esthetic,natural dentition of not less than 20 teeth and not re-quiring recourse to prostheses should be the treatmentgoal for oral health.
It is not possible, however, toquantifytheminimumnumberofteethneededtosatisfy functional demands because these demands vary fromindividual to individual. Furthermore, both dental andﬁnancialconsiderationsstronglyinﬂuencethetreatmentplan, and, in fact, dental arches comprising the anteriorand premolar regions meet the requirements of a func-tional dentition.
It follows that the replacement of missing molar teeth by cantilevers, resin-bonded ﬁxedpartialdentures,implant-supportedprostheses,ordistalextension removable partial dentures may amount toover-treatmentforpatientswithshorteneddentalarches.
Masticatory efﬁciency and masticatory ability are im-portant components of oral functionality, but patientadaptation to changes in dental arch length with pro-gressive loss of teeth is critical to successful treatment.The literature on masticatory efﬁciency and masticatory
Assistant Professor, Department of Restorative Dentistry.
Professor, Department of Oral and Maxillofacial Surgery.
DECEMBER 2004 THE JOURNAL OF PROSTHETIC DENTISTRY 531